The Long Term Plan - are we a step closer to a workforce strategy?

RCP president Professor Andrew Goddard discusses what we’ve learned from the new NHS Long Term Plan, and how to create a sustainable workforce.

The mood music around healthcare is changing, and hopefully for the better. 

The new NHS Long Term Plan sets the scene well, stating that: 

Working in the NHS demands the highest levels of skill and compassion, and the NHS attracts some of the very best people from home and abroad. But, over the past decade, workforce growth has not kept up with need, and the way staff have been supported to work has not kept up with the changing requirements of patients.

Anyone working on the frontline has been all too aware of this in recent years, so it’s good to see NHS leaders being candid about the mountain we have to overcome.

It’s been almost a year since the RCP responded to HEE’s draft workforce strategy, with our ambitious but evidenced ask to double the number of medical student places. During that time there has been progress: the removal of doctors and nurses from the tier 2 visa cap, a step closer towards physician associate regulation, and indications that the medical training initiative will be expanded. But while each of these will help, we need a fully funded, ambitious workforce strategy to ease the pressure and put in place a sustainable model over the next decade. 

[...] we need a fully funded, ambitious workforce strategy to ease the pressure and put in place a sustainable model over the next decade.

Professor Andrew Goddard, RCP president

I hoped that by now we’d be a bit further down the line in terms of that strategy, perhaps even working towards implementation. But we are where we are, and I’m pleased to see a commitment to system-wide oversight of workforce strategy that should make it clear who is accountable.

The plan creates a new ‘national workforce group’ that will be charged with developing a ‘workforce implementation plan’ for publication this year. Hopefully Baroness Dido Harding, NHS Improvement chair, will effectively head up this new group. I’ve met her and she seems to really ‘get it’ when it comes to the workforce.

The plan provides some early insight to the thinking from the centre, and one of the key messages that comes across is that the upcoming government spending review will be crucial. If we can’t secure more money in the spending review then I don’t see how our workforce needs can possibly be met. I will hopefully meet the chancellor in the next couple of weeks and will be making the case for this although have no illusions how hard a challenge making that case is after the £20 billion award, austerity and Brexit. 

On the supply side, the plan highlights the need for further consideration of an additional expansion of medical school places, which is crucial. It also shines a spotlight on accelerated degree programmes and whether they should be expanded, and the role medical schools should play in helping the system shape the workforce it needs.

There are no shortcuts to a fully staffed NHS, but international recruitment will play a role for the foreseeable future.

Professor Andrew Goddard, RCP president

While the plan seems to sidestep the small issue of Brexit, it’s a significant step in the right direction: 'From the inception of the NHS 70 years ago, patients have benefited from the expertise, commitment and compassion of staff who have come to work in the NHS.’

There are no shortcuts to a fully staffed NHS, but international recruitment will play a role for the foreseeable future. We therefore welcome action to create new national arrangements for overseas recruitment and hope ministers will support the Medical Training Initiative and expand its numbers.

There is more detail on the offer for current staff:

To make the NHS a consistently great place to work, we will seek to shape a modern employment culture for the NHS – promoting flexibility, wellbeing and career development, and redoubling our efforts to address discrimination, violence, bullying and harassment.

Plans include increased investment in CPD budgets, the expansion of the Practitioner Health Programme (something which I believe is a real force for good), the re-opening of the associate specialist grade, expansion of multi-professional credentialing, important action on the gender pay gap and a commitment to continue investing in the Workforce Race Equality Standard.

There’s some good news for trainees too, with a commitment to accelerating the implementation of ‘step out and step in’ training programmes and increasing time for supervision. NHS Improvement will also lead on rolling out electronic rosters and e-job plans which if done with the profession should be positive developments.

But, at the moment, we still don’t have a workforce ‘plan’. For that, we need to wait for the workforce strategy and the spending review. Until then, I shall be holding my breath – I hope I don’t go blue.

Professor Andrew Goddard is the president of the RCP. You can follow him on Twitter at @bodgoddard.

This blog is part of a week-long series of discussions focusing on the NHS Long Term Plan. If you have any questions or feedback about the topics covered in these posts please contact